[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1676 Referred in Senate (RFS)]

<DOC>
115th CONGRESS
  2d Session
                                H. R. 1676


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             July 24, 2018

     Received; read twice and referred to the Committee on Health, 
                     Education, Labor, and Pensions

_______________________________________________________________________

                                 AN ACT


 
   To amend the Public Health Service Act to increase the number of 
   permanent faculty in palliative care at accredited allopathic and 
osteopathic medical schools, nursing schools, social work schools, and 
 other programs, including physician assistant education programs, to 
 promote education and research in palliative care and hospice, and to 
   support the development of faculty careers in academic palliative 
                               medicine.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Palliative Care and Hospice 
Education and Training Act''.

SEC. 2. PALLIATIVE CARE AND HOSPICE EDUCATION AND TRAINING.

    (a) In General.--Part D of title VII of the Public Health Service 
Act (42 U.S.C. 294 et seq.) is amended by inserting after section 759 
the following:

``SEC. 759A. PALLIATIVE CARE AND HOSPICE EDUCATION AND TRAINING.

    ``(a) Palliative Care and Hospice Education Centers.--
            ``(1) In general.--The Secretary shall award grants or 
        contracts under this section to entities described in paragraph 
        (1), (3), or (4) of section 799B, and section 801(2), for the 
        establishment or operation of Palliative Care and Hospice 
        Education Centers that meet the requirements of paragraph (2).
            ``(2) Requirements.--A Palliative Care and Hospice 
        Education Center meets the requirements of this paragraph if 
        such Center--
                    ``(A) improves the interprofessional team-based 
                training of health professionals in palliative care, 
                including residencies, traineeships, or fellowships;
                    ``(B) develops and disseminates interprofessional 
                team-based curricula relating to the palliative 
                treatment of the complex health problems of individuals 
                with serious or life-threatening illnesses;
                    ``(C) supports the training and retraining of 
                faculty to provide instruction in interprofessional 
                team-based palliative care;
                    ``(D) supports interprofessional team-based 
                continuing education of health professionals who 
                provide palliative care to patients with serious or 
                life-threatening illness;
                    ``(E) provides students (including residents, 
                trainees, and fellows) with clinical training in 
                interprofessional team-based palliative care in 
                appropriate health settings, including hospitals, 
                hospices, home care, long-term care facilities, and 
                ambulatory care centers;
                    ``(F) establishes traineeships for individuals who 
                are preparing for advanced education nursing degrees, 
                social work degrees, or advanced degrees in physician 
                assistant studies, with a focus in interprofessional 
                team-based palliative care in appropriate health 
                settings, including hospitals, hospices, home care, 
                long-term care facilities, and ambulatory care centers;
                    ``(G) supports collaboration between multiple 
                specialty training programs (such as medicine, nursing, 
                social work, physician assistant, chaplaincy, and 
                pharmacy) and clinical training sites to provide 
                training in interprofessional team-based palliative 
                care; and
                    ``(H) does not duplicate the activities of existing 
                education centers funded under this section or under 
                section 753 or 865.
            ``(3) Expansion of existing centers.--Nothing in this 
        section shall be construed to--
                    ``(A) prevent the Secretary from providing grants 
                to expand existing education centers, including 
                geriatric education centers established under section 
                753 or 865, to provide for education and training 
                focused specifically on palliative care, including for 
                non-geriatric populations; or
                    ``(B) limit the number of education centers that 
                may be funded in a community.
    ``(b) Palliative Medicine Physician Training.--
            ``(1) In general.--The Secretary may make grants to, and 
        enter into contracts with, schools of medicine, schools of 
        osteopathic medicine, teaching hospitals, and graduate medical 
        education programs for the purpose of providing support for 
        projects that fund the training of physicians (including 
        residents, trainees, and fellows) who plan to teach palliative 
        medicine.
            ``(2) Requirements.--Each project for which a grant or 
        contract is made under this subsection shall--
                    ``(A) be staffed by full-time teaching physicians 
                who have experience or training in interprofessional 
                team-based palliative medicine;
                    ``(B) be based in a hospice and palliative medicine 
                fellowship program accredited by the Accreditation 
                Council for Graduate Medical Education;
                    ``(C) provide training in interprofessional team-
                based palliative medicine through a variety of service 
                rotations, such as consultation services, acute care 
                services, extended care facilities, ambulatory care and 
                comprehensive evaluation units, hospices, home care, 
                and community care programs;
                    ``(D) develop specific performance-based measures 
                to evaluate the competency of trainees; and
                    ``(E) provide training in interprofessional team-
                based palliative medicine through one or both of the 
                training options described in paragraph (3).
            ``(3) Training options.--The training options referred to 
        in subparagraph (E) of paragraph (2) are as follows:
                    ``(A) 1-year retraining programs in hospice and 
                palliative medicine for physicians who are faculty at 
                schools of medicine and osteopathic medicine, or others 
                determined appropriate by the Secretary.
                    ``(B) 1- or 2-year training programs that are 
                designed to provide training in interprofessional team-
                based hospice and palliative medicine for physicians 
                who have completed graduate medical education programs 
                in any medical specialty leading to board eligibility 
                in hospice and palliative medicine pursuant to the 
                American Board of Medical Specialties.
            ``(4) Definitions.--For purposes of this subsection, the 
        term `graduate medical education' means a program sponsored by 
        a school of medicine, a school of osteopathic medicine, a 
        hospital, or a public or private institution that--
                    ``(A) offers postgraduate medical training in the 
                specialties and subspecialties of medicine; and
                    ``(B) has been accredited by the Accreditation 
                Council for Graduate Medical Education or the American 
                Osteopathic Association through its Committee on 
                Postdoctoral Training.
    ``(c) Palliative Medicine and Hospice Academic Career Awards.--
            ``(1) Establishment of program.--The Secretary shall 
        establish a program to provide awards, to be known as the 
        `Palliative Medicine and Hospice Academic Career Awards', to 
        eligible individuals to promote the career development of such 
        individuals as academic hospice and palliative care physicians.
            ``(2) Eligible individuals.--To be eligible to receive an 
        award under paragraph (1), an individual shall--
                    ``(A) be board certified or board eligible in 
                hospice and palliative medicine; and
                    ``(B) have a junior (non-tenured) faculty 
                appointment at an accredited (as determined by the 
                Secretary) school of medicine or osteopathic medicine.
            ``(3) Limitations.--No award under paragraph (1) may be 
        made to an eligible individual unless the individual--
                    ``(A) has submitted to the Secretary an 
                application, at such time, in such manner, and 
                containing such information as the Secretary may 
                require, and the Secretary has approved such 
                application;
                    ``(B) provides, in such form and manner as the 
                Secretary may require, assurances that the individual 
                will meet the service requirement described in 
                paragraph (6); and
                    ``(C) provides, in such form and manner as the 
                Secretary may require, assurances that the individual 
                has a full-time faculty appointment in a health 
                professions institution and documented commitment from 
                such institution to spend a majority of the total 
                funded time of such individual on teaching and 
                developing skills in education in interprofessional 
                team-based palliative care.
            ``(4) Maintenance of effort.--An eligible individual who 
        receives an award under paragraph (1) shall provide assurances 
        to the Secretary that funds provided to the eligible individual 
        under this subsection will be used only to supplement, not to 
        supplant, the amount of Federal, State, and local funds 
        otherwise expended by the eligible individual.
            ``(5) Amount and term.--
                    ``(A) Amount.--The amount of an award under this 
                subsection shall be equal to the award amount provided 
                for under section 753(c)(5)(A) for the fiscal year 
                involved.
                    ``(B) Term.--The term of an award made under this 
                subsection shall not exceed 5 years.
                    ``(C) Payment to institution.--The Secretary shall 
                make payments for awards under this subsection to 
                institutions, including schools of medicine and 
                osteopathic medicine.
            ``(6) Service requirement.--An individual who receives an 
        award under this subsection shall provide training in 
        palliative care and hospice, including the training of 
        interprofessional teams of health care professionals. The 
        provision of such training shall constitute a majority of the 
        total funded obligations of such individual under the award.
    ``(d) Palliative Care Workforce Development.--
            ``(1) In general.--The Secretary shall award grants or 
        contracts under this subsection to entities that operate a 
        Palliative Care and Hospice Education Center pursuant to 
        subsection (a)(1).
            ``(2) Application.--To be eligible for an award under 
        paragraph (1), an entity described in such paragraph shall 
        submit to the Secretary an application at such time, in such 
        manner, and containing such information as the Secretary may 
        require.
            ``(3) Use of funds.--Amounts awarded under a grant or 
        contract under paragraph (1) shall be used to carry out the 
        fellowship program described in paragraph (4).
            ``(4) Fellowship program.--
                    ``(A) In general.--Pursuant to paragraph (3), a 
                Palliative Care and Hospice Education Center that 
                receives an award under this subsection shall use such 
                funds to offer short-term intensive courses (referred 
                to in this subsection as a `fellowship') that focus on 
                interprofessional team-based palliative care that 
                provide supplemental training for faculty members in 
                medical schools and other health professions schools 
                with programs in psychology, pharmacy, nursing, social 
                work, physician assistant education, chaplaincy, or 
                other health disciplines, as approved by the Secretary. 
                Such a fellowship shall be open to current faculty, and 
                appropriately credentialed volunteer faculty and 
                practitioners, who do not have formal training in 
                palliative care, to upgrade their knowledge and 
                clinical skills for the care of individuals with 
                serious or life-threatening illness and to enhance 
                their interdisciplinary and interprofessional teaching 
                skills.
                    ``(B) Location.--A fellowship under this paragraph 
                shall be offered either at the Palliative Care and 
                Hospice Education Center that is sponsoring the course, 
                in collaboration with other Palliative Care and Hospice 
                Education Centers, or at medical schools, schools of 
                nursing, schools of pharmacy, schools of social work, 
                schools of chaplaincy or pastoral care education, 
                graduate programs in psychology, physician assistant 
                education programs, or other health professions schools 
                approved by the Secretary with which the Centers are 
                affiliated.
                    ``(C) Continuing education credit.--Participation 
                in a fellowship under this paragraph shall be accepted 
                with respect to complying with continuing health 
                profession education requirements. As a condition of 
                such acceptance, the recipient shall subsequently 
                provide a minimum of 18 hours of voluntary instruction 
                in palliative care content (that has been approved by a 
                palliative care and hospice education center) to 
                students or trainees in health-related educational, 
                home, hospice, or long-term care settings.
            ``(5) Targets.--A Palliative Care and Hospice Education 
        Center that receives an award under paragraph (1) shall meet 
        targets approved by the Secretary for providing training in 
        interprofessional team-based palliative care to a certain 
        number of faculty or practitioners during the term of the 
        award, as well as other parameters established by the 
        Secretary.
            ``(6) Amount of award.--Each award under paragraph (1) 
        shall be in the amount of $150,000. Not more than 24 Palliative 
        Care and Hospice Education Centers may receive an award under 
        such paragraph.
            ``(7) Maintenance of effort.--A Palliative Care and Hospice 
        Education Center that receives an award under paragraph (1) 
        shall provide assurances to the Secretary that funds provided 
        to the Center under the award will be used only to supplement, 
        not to supplant, the amount of Federal, State, and local funds 
        otherwise expended by such Center.
    ``(e) Palliative Care and Hospice Career Incentive Awards.--
            ``(1) In general.--The Secretary shall award grants or 
        contracts under this subsection to individuals described in 
        paragraph (2) to foster greater interest among a variety of 
        health professionals in entering the field of palliative care.
            ``(2) Eligible individuals.--To be eligible to receive an 
        award under paragraph (1), an individual shall--
                    ``(A) be an advanced practice nurse, a social 
                worker, physician assistant, pharmacist, chaplain, or 
                student of psychology who is pursuing a doctorate, 
                masters, or other advanced degree with a focus in 
                interprofessional team-based palliative care or related 
                fields in an accredited health professions school; and
                    ``(B) submit to the Secretary an application at 
                such time, in such manner, and containing such 
                information as the Secretary may require.
            ``(3) Conditions of award.--As a condition of receiving an 
        award under paragraph (1), an individual shall agree that, 
        following completion of the award period, the individual will 
        teach or practice palliative care in health-related 
        educational, home, hospice, or long-term care settings for a 
        minimum of 5 years under guidelines established by the 
        Secretary.
            ``(4) Payment to institution.--The Secretary shall make 
        payments for awards under paragraph (1) to institutions that 
        include schools of medicine, osteopathic medicine, nursing, 
        social work, psychology, chaplaincy or pastoral care education, 
        dentistry, and pharmacy, or other allied health discipline in 
        an accredited health professions school or program (such as a 
        physician assistant education program) that is approved by the 
        Secretary.
    ``(f) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, $15,000,000 for each of the 
fiscal years 2019 through 2023.''.
    (b) Effective Date.--The amendment made by this section shall be 
effective beginning on the date that is 90 days after the date of 
enactment of this Act.

SEC. 3. HOSPICE AND PALLIATIVE NURSING.

    (a) Nurse Education, Practice, and Quality Grants.--Section 
831(b)(3) of the Public Health Service Act (42 U.S.C. 296p(b)(3)) is 
amended by inserting ``hospice and palliative nursing,'' after 
``coordinated care,''.
    (b) Palliative Care and Hospice Education and Training Programs.--
Part D of title VIII of the Public Health Service Act (42 U.S.C. 296p 
et seq.) is amended by adding at the end the following:

``SEC. 832. PALLIATIVE CARE AND HOSPICE EDUCATION AND TRAINING.

    ``(a) Program Authorized.--The Secretary shall award grants to 
eligible entities to develop and implement, in coordination with 
programs under section 759A, programs and initiatives to train and 
educate individuals in providing interprofessional team-based 
palliative care in health-related educational, hospital, hospice, home, 
or long-term care settings.
    ``(b) Use of Funds.--An eligible entity that receives a grant under 
subsection (a) shall use funds under such grant to--
            ``(1) provide training to individuals who will provide 
        palliative care in health-related educational, hospital, home, 
        hospice, or long-term care settings;
            ``(2) develop and disseminate curricula relating to 
        palliative care in health-related educational, hospital, home, 
        hospice, or long-term care settings;
            ``(3) train faculty members in palliative care in health-
        related educational, hospital, home, hospice, or long-term care 
        settings; or
            ``(4) provide continuing education to individuals who 
        provide palliative care in health-related educational, home, 
        hospice, or long-term care settings.
    ``(c) Application.--An eligible entity desiring a grant under 
subsection (a) shall submit an application to the Secretary at such 
time, in such manner, and containing such information as the Secretary 
may reasonably require.
    ``(d) Eligible Entity.--For purposes of this section, the term 
`eligible entity' shall include a school of nursing, a health care 
facility, a program leading to certification as a certified nurse 
assistant, a partnership of such a school and facility, or a 
partnership of such a program and facility.
    ``(e) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $5,000,000 for each of fiscal 
years 2019 through 2023.''.

SEC. 4. DISSEMINATION OF PALLIATIVE CARE INFORMATION.

    Part A of title IX of the Public Health Service Act (42 U.S.C. 299 
et seq.) is amended by adding at the end the following new section:

``SEC. 904. DISSEMINATION OF PALLIATIVE CARE INFORMATION.

    ``(a) In General.--Under the authority under section 902(a) to 
disseminate information on health care and on systems for the delivery 
of such care, the Director may disseminate information to inform 
patients, families, and health professionals about the benefits of 
palliative care throughout the continuum of care for patients with 
serious or life-threatening illness.
    ``(b) Information Disseminated.--
            ``(1) Mandatory information.--If the Director elects to 
        disseminate information under subsection (a), such 
        dissemination shall include the following:
                    ``(A) Palliative care.--Information, resources, and 
                communication materials about palliative care as an 
                essential part of the continuum of quality care for 
                patients and families facing serious or life-
                threatening illness (including cancer; heart, kidney, 
                liver, lung, and infectious diseases; as well as 
                neurodegenerative disease such as dementia, Parkinson's 
                disease, or amyotrophic lateral sclerosis).
                    ``(B) Palliative care services.--Specific 
                information regarding the services provided to patients 
                by professionals trained in hospice and palliative 
                care, including pain and symptom management, support 
                for shared decisionmaking, care coordination, 
                psychosocial care, and spiritual care, explaining that 
                such services may be provided starting at the point of 
                diagnosis and alongside curative treatment and are 
                intended to--
                            ``(i) provide patient-centered and family-
                        centered support throughout the continuum of 
                        care for serious and life-threatening illness;
                            ``(ii) anticipate, prevent, and treat 
                        physical, emotional, social, and spiritual 
                        suffering;
                            ``(iii) optimize quality of life; and
                            ``(iv) facilitate and support the goals and 
                        values of patients and families.
                    ``(C) Palliative care professionals.--Specific 
                materials that explain the role of professionals 
                trained in hospice and palliative care in providing 
                team-based care (including pain and symptom management, 
                support for shared decisionmaking, care coordination, 
                psychosocial care, and spiritual care) for patients and 
                families throughout the continuum of care for serious 
                or life-threatening illness.
                    ``(D) Research.--Evidence-based research 
                demonstrating the benefits of patient access to 
                palliative care throughout the continuum of care for 
                serious or life-threatening illness.
                    ``(E) Population-specific materials.--Materials 
                targeting specific populations, including patients with 
                serious or life-threatening illness who are among 
                medically underserved populations (as defined in 
                section 330(b)(3)) and families of such patients or 
                health professionals serving medically underserved 
                populations. Such populations shall include pediatric 
                patients, young adult and adolescent patients, racial 
                and ethnic minority populations, and other priority 
                populations specified by the Director.
            ``(2) Required publication.--Information and materials 
        disseminated under paragraph (1) shall be posted on the 
        Internet websites of relevant Federal agencies and departments, 
        including the Department of Veterans Affairs, the Centers for 
        Medicare & Medicaid Services, and the Administration on Aging.
    ``(c) Consultation.--The Director shall consult with appropriate 
professional societies, hospice and palliative care stakeholders, and 
relevant patient advocate organizations with respect to palliative 
care, psychosocial care, and complex chronic illness with respect to 
the following:
            ``(1) The planning and implementation of the dissemination 
        of palliative care information under this section.
            ``(2) The development of information to be disseminated 
        under this section.
            ``(3) A definition of the term `serious or life-threatening 
        illness' for purposes of this section.''.

SEC. 5. CLARIFICATION.

    None of the funds made available under this Act (or an amendment 
made by this Act) may be used to provide, promote, or provide training 
with regard to any item or service for which Federal funding is 
unavailable under section 3 of Public Law 105-12 (42 U.S.C. 14402).

SEC. 6. ENHANCING NIH RESEARCH IN PALLIATIVE CARE.

    (a) In General.--Part B of title IV of the Public Health Service 
Act (42 U.S.C. 284 et seq.) is amended by adding at the end the 
following new section:

``SEC. 409K. ENHANCING RESEARCH IN PALLIATIVE CARE.

    ``The Secretary, acting through the Director of the National 
Institutes of Health, shall develop and implement a strategy to be 
applied across the institutes and centers of the National Institutes of 
Health to expand and intensify national research programs in palliative 
care in order to address the quality of care and quality of life for 
the rapidly growing population of patients in the United States with 
serious or life-threatening illnesses, including cancer; heart, kidney, 
liver, lung, and infectious diseases; as well as neurodegenerative 
diseases such as dementia, Parkinson's disease, or amyotrophic lateral 
sclerosis.''.
    (b) Expanding Trans-NIH Research Reporting To Include Palliative 
Care Research.--Section 402A(c)(2)(B) of the Public Health Service Act 
(42 U.S.C. 282a(c)(2)(B)) is amended by inserting ``and, beginning 
January 1, 2019, for conducting or supporting research with respect to 
palliative care'' after ``or national centers''.

SEC. 7. CUT-GO OFFSET.

    The total amount authorized to be appropriated to the Office of the 
Secretary of Health and Human Services for each of fiscal years 2019 
through 2023 is the amount that is $20,000,000 below the total amount 
appropriated to such Office for fiscal year 2018.

            Passed the House of Representatives July 23, 2018.

            Attest:

                                                 KAREN L. HAAS,

                                                                 Clerk.